Point of care? The King's Fund - patient experience

The real 'point of care' is that there are several points with many perspectives:


Patient (person) - Care professional - Manager - Carer
Public (citizen) - Student - Lecturer - Service User Groups
Physical - Emotional - Political - Social
Patient - Inspectors - CEO information governance - Commissioners

Don't drown seeking gaps in processes. All of the P's count!

The King's FundThe Point of Care: Improving Patients' Experience.


Image source:
Multiple Faces: Insight Management Group

Hodges' model: asking for a fight while searching for the cosmic background holistic radiation

There is an awful lot to fight for at the moment; what with the countdown to Copenhagen and the ongoing struggles of the new economic butterfly from its cocoon - its life plainly in the balance - even before its wings have dried.

Meanwhile, in its four quiet corners Hodges' model is also asking for a fight. Now don't panic, the fight in prospect is an orderly, disciplined affair as per Queensberry Rules(?).

Disciplines new and old seek structures upon which to base their questions, hypotheses, methods and theories. This explains in part the structure of Hodges' model. In facilitating holistic and integrated care through:

• personal and group reflection
• cross curricula application
• socio-technical perspectives
• bridging the theory - practice gap
• ....

Hodges' model is actually asking us to if not tear down the axes, then at least render them irrelevant.

In the same way (well almost) we now recognise new 'super' structures in cosmology, in time we may realise new semantic - ontological structures across and between the existing humanistic - mechanistic domains of h2cm.

Additional links:
United Nations Framework Convention on Climate Change


Image source: Barnabu - Google Earth add-ons and visualizations.

Nursing management consultants & being optically challenged

Being somewhat optically challenged at present (need new glasses!) I have nonetheless managed to sort some old papers. I came across a more recent news item from the Nursing Times 8 September, p.3 by Sally Gainsbury. What use is late news?

I raise this now because public sector health finance provides the impetus, so this subject is perpetual motion. It is also reported ongoing by HSJ. I refer to this not to take sides, but to acknowledge that politically there is a need to make decisions and find the required £20bn efficiency savings. The news line reads:

DH told 1,500 district nurses could go with no damage to patient care

The item focuses on a report for the DoH produced by McKinsey management consultants. The government has distanced itself from the reports recommendations, but the need for action remains. The Nursing Times news item includes two clocks (with the total nursing time available depicted as 1 hour) that break down the time spent on patients on general medical wards and community wards. While this is just one aspect of a report of more than 100 pages, the findings are of great interest. ...

GENERAL WARD: 15 mins Physical care; 10 mins Psychosocial care; 35 mins non-patient care.
COMMUNITY NURSES: 17 mins Antenatal activities; 13 mins Postnatal; 27 mins npc; 3 mins other and classes.
I have not worked on a general or mental health ward for a long time, but I was surprised to see the time spent on patient being less on the wards than the community - 25 minutes v. 30 minutes. There are challenges in comparing different clinical areas, but I would have thought travel, administration - including paper and e-record data entry would impinge much more on community. On mental health wards there has been an effort to free nurses to nurse - with protected time? So pause for thought there - but only for a moment....

Thinking about community - providers will no doubt vary in the way (district) nursing teams are organized, the location of their bases and how that impacts average journey times. Districts also vary in the way the population is distributed, especially those neighbourhoods were social and economic deprivation is higher and need may be increased.

This is why access to GIS (geographical information systems) by team managers and members is crucial and should not just be some esoteric academic and intelligence artifact. While we should not under estimate the potential use of GIS to inform inpatient care, it is community services that are best placed to benefit from improved intelligence, planning and decisions.

There is a long thread here and the politicians of all parties know it leads into the forest ....

For example, much can be read in a single word "... McKinsey found that only 15 minutes was on the "physical care" of patients while the remaining 10 minutes went on "psychosocial" care, such as talking to patients." I hope that 'only' does not suggest that talking to patients is 2nd best, even though basic nursing care is the factor in the news regarding public perception of the quality of nursing care. This is a constant problem as we move to outcomes. Are we going to have patients saying - "The physical care was excellent, but I felt like I was in a religious retreat. Nobody hardly spoke, explained anything." Patient education, self care, staying well, the effective use of medication and treatment ... is predicated on psychosocial engagement.

What is also very troubling is that cost savings might mean detrimental changes in the skill-mix; the ratio of qualified to health care assistant staff. Some of the best 'natural' nurses I have worked with and work with today are dedicated HCAs. They have a major role and contribution to make, but if safety gains are to be maintained and improved upon then 'safe' skill-mix is critical.

Given the present demographic, 'nurses' are not new to cuts. In the public sector cuts are part of that perpetual motion I mentioned at the start. What frustrates is working on the holistic care mosaic to produce something that is safe, effective, quality care; then as we come to finally add the threads - clinical supervision, PDP, health IT, outcome measures, public engagement we have to unravel and start again.

Image source used with permission and thanks: D L Ennis. Visual Thoughts http://dlennis.wordpress.com/

Being all things to all people: and virtually 2nd

I don't ever want to be like 'jam', as that may indicate that one has also become a statistic. In IcT though it's very difficult to spread yourself as completely as you might like. The desire and apparent need to 'multi-webtech' is profound. So it is gratifying (if that's the right word?) when news comes through that the grass is not always greener being an 'early adopter' and in with the in-crowd. For me this missed opportunity and news comes c/o Second Life.

As with the philosophy dialogue there is a virtual effort that dates back to 1991. I realised ages ago that if you are going to build a community dedicated to the compound conceptual space that is Hodges' model then virtual - augmented reality is the space to Be. I have long thought of the model as the ideal portal for a virtual learning environment. So here is news that actually indicates a trend, a shift in the maturity of the web as the established newspaper media also takes stock of traditional journalism, its investment in web content and how to monetise. The latest sign of change is today's news of a possible NewsCorp and Microsoft alliance against Google in The Independent. Here's the Second Life news item:

Subject: [NetBehaviour] Second Life To Remove Free Content From Web Search.

"In a move that continues to shake the Second Life community of content creators, merchants, and consumers, Linden Labs has declared that free virtual content will no longer be searchable without listing payments on their website portal - (formerly at:)
(http://wiki.secondlife.com/wiki/Linden_Lab_Official:Managing_Freebies_on_Xstreet_SL_Roadmap_FAQ);
and additional fees will be added with the intention of discouraging content listed for inexpensive selling prices. The move is particularly troubling because the online Web listing service is the de facto search engine for virtual content in Second Life, since the in-world search tools are unable to provide information about an object beyond name and location - basic textual descriptions, pictures, or descriptions of licensing, size, or content-category are not possible. While initially the change was explained as a response to community feedback, the residents involved in this feedback process were revealed to be fewer than 100 in number, primarily larger merchants among a community of millions. Within 24 hours of the announcement, the feedback thread (https://blogs.secondlife.com/message/38923#38923) has swelled to over 1,000 overwhelmingly negative responses. Additionally, in-world protests have erupted throughout the day, and over 20,000 objects have been voluntarily removed from the online store by angered merchants."

Read on for more details on the brouhaha.

Adding to the controversy are the officially stated justifications in the FAQ
(http://wiki.secondlife.com/wiki/Linden_Lab_Official:Managing_Freebies_on_Xstreet_SL_Roadmap_FAQ),
such as 'They [free content listings] hinder the shopping experience because a "sort by price" puts all freebies first,' and the perplexing statement 'They [free listings] garner so much attention that Residents are driven toward the freebies instead of quality, fairly priced items.'

Various independent virtual content listing sites have been proposed, such as Meta-life.net and Slapt.me, but attempts to post this information on the Second Life forums has been met with aggressive administrative censorship of these links.

Found originally on slashdot.org
My source: CI list and marc garrett (FurtherField)

Additional links:
FurtherField
NetBehaviour for networked distributed creativity

Learning Disability & Hodges' model

It is Brian E Hodges who created Hodges' model in the early 1980s and one of his qualifications is RNMH - Registered Nurse for the Mentally Handicapped. Today this course and qualification is known as RNLD, that is - Registered Nurse for Learning Disability. What has not changed is the foresightedness and need for a political care domain within the model.

You might well ask:

What is so foresighted about that?

Well a moments reflection and we can soon appreciate the extent to which the following have changed since the early - mid 1980s, not only in terms of theory, policy and practice, but attitudes also:

• learning disability - independent living
• human rights
• institutionalised care
• role of medication - side effects, consent
• mental capacity
• epilepsy
• educational opportunity
• special needs
• social inclusion
• nurse training
• social care
• outcomes directed care

The foresight that Brian extended in realizing the opposition of intrapersonal - political retains its relevance today. There is still so much to do.

There is much more that the existing and any new website could offer in supporting the care agenda, its delivery and refinement for this group of people and their families. It pains me that to date there is a gap here on W2tQ (a paltry six tags), website and links content. By rights the links pages deserve a specific listing for this client group, either in the intrapersonal or political domains. What do you think? More than this though what future content types might support the care, welfare and well-being of people with a learning disability? If you have any ideas, suggestions, or guidance to offer please get in touch.

Additional links:

British Institute of Learning Disabilities
Centre for Studies on Inclusive Education
Foundation for People with Learning Disabilities
Mencap

Nurses as modellers and informaticians: surely not!

Nursing is still trying to escape and evade the sexual 'Carry On' stereotypes that have plagued the profession in the popular imagination. For the majority of people talk of nursing and models more readily conjures up visions of catwalks than an academic pursuit.

You can still see and hear the response of bright-eyed girls and boys (aged 9-10...) to the age-old question: "What do you want to be when you grow up?" The answer: "I want to be a nurse and help people get better!" Even though youngsters are more sophisticated these days (the reference to girls and boys is not just me being politically correct), they are still most likely primarily motivated by humanistic leanings as opposed to wanting to pursue the necessary studies in the sciences.

Despite efforts worldwide practicing nurses do not all see themselves as data modellers enthralled by IcT. IT isn't usually why they came to nursing, although many mature students may have started their career in the IT sector. Chapter 1 of Programming the Semantic Web highlights how a basic table is a model (p.6-7). So of course gifted with natural language we are all data modellers. Hodges model then is the ubiquitous high-level data model - a two-by-two table and a whole lot more.

An invitation to mine data, gather information and deliver nuggets of knowledge.

Ref:
Programming the Semantic Web: Build Flexible Applications with Graph Data
By Toby Segaran, Colin Evans, Jamie Taylor
Publisher: O'Reilly Media
Released: July 2009

The WWW, spam, personality - mood and idealism

According to Technology Guardian 19.11.2009 Cisco estimated late last year that there are around 200bn junk e-mails a day. The (newspaper) article Mixed Messages states that although filters intercept a vast amount of spam, it remains the route for malware and viruses now disguised as 'friend' invites. What is the impact of that ever growing volume of junk? Yesterday being World Philosophy Day reading this I was instantly reminded of:

• ideal worlds;
• the web;
• and a lady who finally ventured out to the shops.

The cogs turned as I wondered about what the web would be like without that spam. What would the internet be like if even for a day the spammers - and criminals - lay down their keyboards, phones, servers, botnets ... and we could see what the web might really be like? Or is it that spam just represents noise, the noise that is inevitably part of any system?

Then thinking about yesterday and setting intelligence aside for a moment - what would the world be like if everyone exercised true common sense? Imagine there being no totally illogical, knee-jerk, prejudiced, greed, hatred, violence, purely emotionally driven decisions and actions in our homes, communities, boardrooms, town halls and seats of governance. And then finally that lady, who having been on tranquillisers for decades finally kicked them into touch. In the same way we don't know the real internet, this lady did not know herself, neither did her rather limited social network.

It's a case of will the real internet and Mrs Goggins please stand up!

Original image source: Digital stores

Additional link:
The Honeynet Project

World Philosophy Day 2009

The world's population really needs the skills (literacy!) to balance arguments and debate issues. Today being World Philosophy Day, 19 November 2009 we can see this need as global events re-frame our words. For decades now some of the world's cities - capitals have become synonymous with fevered political debate, equality, equity, poverty, power.... 'Copenhagen' is the latest example, stressing the need for informed argument and rationale thinking on an individual and group level, as the UNESCO introduction reveals:

Ever since its inauguration as a “Philosophy Day at UNESCO” in 2002 and particularly since its institutionalization in 2005 as a “World Philosophy Day”, this celebration of philosophy has inspired much enthusiasm. With its aim to bring philosophy closer to everyone, academics, students and the general public alike have all shown great interest in this activity that offers new opportunities and space for philosophical reflection, critical thinking and debate.

My previous studies comprised a joint honours degree in computing and philosophy, which may account for the appeal of Hodges' model and the reflections here on W2tQ. As mentioned previously, in the 1990s I wrote a dialogue (of sorts):

The aims of this 'dialogue' are threefold. First, simply to explore through the minds and voices of two ancient characters, contemporary nursing informatics and telematics issues. Secondly, to test the viability of the dialogue as an alternative format to the usual academic paper. And thirdly, to introduce unfamiliar readers (students?) to 'the' master of the dialogue form - Plato.
Readers may (hopefully) be stimulated to seek out Plato's works, which are freely available in affordable paperback editions. 'The Last Days of Socrates' is recommended as a starting point. Plato captures in the dialogues the technique employed by Socrates, that still bears his name - 'Socratic questioning'.
As health professionals search for ways to reassert values amid unprecedented technical and social change, philosophy is once more on the agenda. This attempted 'dialogue' has two protagonists. Telemachus, who is in name from Homer's Odyssey and other Hellenic literature. The name appeals to me here due to the study of 'tele'-matics, a key branch of informatics research.
Epictetus (50-120A.D.) was a philosopher of the stoic school. Sometimes we find unexpected connections in things, as with Epictetus: nursing - health - ethics/values - philosophy - Enchiridion (Manual) health - how to live ones life - leadership - 3,000 drachmas paid for E.'s lamp after his death - Florence Nightingale - nursing!
Telemachus is a student of the Academy established by Aristotle, starting his third year of nurse training. Epictetus is staged as a professor, a member of the faculty for health. With apologies...

Nursing Telemachus and Computers

There is also a philosophy listing on the INTER-INTRAPERSONAL links page. One initiative here in the UK which I must admit I have not attended thus far is Philosophy in Pubs. Many colleges also do courses were you do not necessarily have to sign-up for the whole deal - that is exams - but you can still enjoy what is a marvellous subject. I remember a lady of some 70 years who did just that with literature, she also beautifully shredded my unspoken thoughts on Sylvia Plath's Ariel and other works. So do go and check what's happening in your area.

Despite the significance of today it is troubling that the existence and value of university philosophy departments can be thrown into doubt as recently as March this year. I must check what happened in Liverpool? And also wonder what there is to learn from Eastern and African philosophy?

Ageism: Four year old ideas and big pictures

Models of nursing are still alive and kicking on nurse education curricula. One day ;-) I will do that literature search and look at the numbers and dates of publication. It seems reasonable to assume that there are now fewer newborn and infant examples compared with the 70-90s. While internet time may be compressed there must be strange goings on in nursing academia if some students (apparently) only refer to sources within the past four years. The field is going to be very furrowed with so many wheels being brought to bear on theory and practice and then suddenly cast aside to rust (if mechanistic) or go rotten (if humanistic) or perhaps both (holistic). Wither a space for creativity and innovation that also supports sustainability, continuity, stability, integrity...? Are they mutually exclusive?

If there is an over-four-year-can't-go-there! rule then logic suggests that a newly realised evidence-based method or tool has a limited life span for some students. This constant, iterative, critique of theory and practice IS crucial, but in terms of doing those things that depend on nurses weaving between subject disciplines and other professions where is the big picture? How old are your stories: the ones that really count?

Dementia, Drugs, Nursing by Degr[EE]s and Care Transitions

Of all the policy issues that government faces the care of an ageing population is irresistible in demanding attention. This one will keep tapping MPs, policy makers and families ... on the shoulder. It will constantly cycle through the government's gamut of official papers. In the UK this past week people suffering with dementia and the prescribing of anti-psychotic medication and deaths arising from the same has been highlighted and not for the first time.

Whilst my spare time web attention is also given to nursing IT and socio-technical matters, as an NHS community mental health nurse these vulnerable individuals are the primary focus of my work and that of my colleagues. There are three strands to the current role - in brief:

• Nursing home liaison - dedicated to specific homes;
• assessment, intervention and subsequent review;
• working with social services integration project duty desk.

Drugs are of course a day-to-night constant for all nurses, with the addition of debate across all the knowledge domains of Hodges' model - that is interpersonal, sciences, sociology and political domains of knowledge. We have witnessed this in the scientific evidence of substance misuse and the government misuse of drugs advisory group 'difficulties' and now this issue which is professionally closer to home: right on the doorstep in fact.

'Home' is the operative word as many of the people concerned reside in residential care and nursing home facilities. Let's scratch the surface of what we already know:

• These people can be very confused, vulnerable, they may be agitated and not easily reassured and placated without repeated skilled intervention.
• Facilities are subject to inspection and care standards.
• Many do not have an advocate in the sense of a family member who visits at least weekly and will challenge and question care and prescribing.
• Older people may already be on several drugs (polypharmacology) due to other chronic health problems.
• There is still a disconnect (holistic gap!) between the interdependence between mental - physical health problems.
• These facilities are that individual's home - they continue to live and hence age there.
• Homes get attached to their residents; in the best homes they (and their relatives and friends) become part of a greatly extended family.
• For confused people there is a potential community (albeit a closed one) that people can participate in or choose to stay in their room. This space, the freedom of movement it affords - toing-and-froing - should itself be subject to history taking and ongoing assessment.
• The quality of this community depends on the core staff and additional skills seen as essential by the organisation and care standards, e.g. activities coordinators, residents committees that also engage family, friends.
• NVQs and mandatory training in the sector is making a positive difference.
• There remains a high level of staff turnover.
• Some homes are dual-registered catering for nursing care with another floor for dementia care (does a 1st or 2nd floor provide secure access to a garden in the summer?).
• Homes rely greatly on the specialist services of local community mental health service, also given the placement of people in homes 'out of area' this involvement may be more remote and subject to varying degrees of engagement and hence quality.
• Homes are businesses and the movement of clients incurs changes in income.
• The quality and standards of architecture and design for residential accommodation has seen great strides in the past decade.

The bottom line (no pun intended) is the need for macro-management in terms of multidisciplinary team input; that is, primary care, modern matron, mental health and micro-management in terms of personalised care with regular review of physical and mental well-being and medication.

As government's of all persuasion utter the mantra of education! education! education! - this must be heard in the residential and nursing home care sector. The good news is that standards, competencies and the quality of care in the sector are improving; but to education we must add environment! environment! environment! As someone who appreciates aesthetics in design we should all be aware of the seductive properties of newly designed and furnished nursing homes (new carpets plus brand new flat screen LCD TVs does not automatically mean multi-dimensional care).

The counterpoint to this are the long stay, geriatric wards of old (c. 1977-1984) and the reaction of family friends when they first walked through the (three) doors.

They were distraught.

In time they came to appreciate the efforts of the staff and the importance of the knowledge, skills and attitude of the ward team. They could understand and see what staff were trying to achieve regards individualised care. Many responded to the open invitation to be part of the team, to get involved. Yes, the environment was far from 'right' (it was terrible), but it's the people on all sides of the care equation that count. It is the same today, but if the care environment is no longer appropriate then people should be moved to a place were their care needs can be met without recourse to anti-psychotic medication. That is why initial and ongoing person-centred assessment is very important.

It is very difficult to predict future needs and yet trying to anticipate them is the primary nursing challenge. If life is a book, then the turning of the page that ends one chapter and starts a-new is a non-trivial transition. That said and make no mistake, it is not for dramatic effect that we describe the behaviour of some individuals as challenging. Drugs are a tool and like all tools it is how they are used in assuring the highest standards of care, retaining personal dignity and maximising whatever quality of life an individual can achieve. Accounting for care interventions including medication is critical. If due diligence cannot be effectively applied in the financial sector then perhaps there is scope for due diligence in the care of older adults*?

*Some clients are under 65 years of age.

2nd iConference Workshop on Sociotechnical Systems

Workshop: “Keywords of the Sociotechnical”
Organizers:
Steven Jackson, University of Michigan;
David Ribes, Georgetown University;
Sean Goggins, Drexel University

We invite participation in the 2nd iConference Workshop on Sociotechnical systems, to be held prior to the iConference on the University of Illinois campus in Urbana-Champaign on February 3, 2010. To see “who we are”, check out the facebook group – “Researchers of the Sociotechnical” or our website at http://www.sociotech.net .

You may register here: https://www.ischools.org/conftool/

In 1975 British cultural historian Raymond Williams published his influential pocket dictionary Keywords: A Vocabulary of Culture and Society. The text tackled the most difficult, contested and often under explored terms in his field: culture, agency, technology, etc. Today studies of sociotechnical systems finds itself at a place not unlike where British Cultural Studies was in the early 70s: a meeting place for scholars of multiple disciplinary backgrounds deploying concepts and tools whose commonality (and separateness) of meaning has yet to be fully established.

What are the words that transcend the sectional interests of, say, organizational science and HCI, CSCW and science and technology studies? When an HCI researcher and a social informatics scholar say ‘system’ or ‘design,’ are they really talking about the same thing? Relatedly, how do we go about attaching these keywords to concrete socio-technical research
problems in our diverse disciplinary traditions? How do we go about transforming a cross-field coincidence of research objects (Wikipedia, eScience, social practices in pervasive computing spaces, and countless others) into a mutually informed set of research problems?

This workshop will provide a venue to gather and discuss our intellectual traditions, research objects, and vocabularies in order to elaborate and clarify the keywords of the sociotechnical.

*Studying Sociotechnical Systems*

The workshop builds on and extends efforts that have included the 2008 & 2009 Summer Research Institute of the Consortium for the Science of Sociotechnical Systems (CSST). These Research Institutes, supported by the National Science Foundation and held at the University of Michigan (2008) and Syracuse University (2009), brought together a diverse set of researchers from fields as diverse as science and technology studies, human-computer interaction, management and organizational studies, library and information science, sociology, social informatics, and computer science, to begin exploring and framing a future research agenda centered on socio-technical research.

David Ribes, Ph.D.
Communication, Culture & Technology (CCT)
Georgetown University
http://davidribes.com

Additional links:

The Consortium for the Science of Sociotechnical Systems (CSST) [and above image source]

Hodges' model: the puzzle of holistic care

Like many day-to-day 'customer' facing businesses, it is very difficult to get health and social care just right ('just' is not good enough).


If you are faffing about with clothes and belongings when an emergency ensues you have just become an adornment yourself: one that is in the way. In the SCIENCES domain fail to assess mobility and balance and who is going to catch them when they fall? Not you: health and safety! It's a problem for the mental health team is it? Could this confused gentleman be constipated? Nice place is it? OK, crease your eyes up and tell me where the door is; what about the hand-rail?

Are you ready to crowd surf?

That's good because there is an abundance of outstretched hands ready in the SOCIOLOGICAL domain. If, however, you do not attend to the patient's instructions regards information sharing - even if it was a relative you spoke to - just where are you going to hide?

(Ouch - that's gotta hurt! Sounds like they dropped you.)

Fail to assess mood and motivation comprehensively in the INTERPERSONAL domain and will you be able to say how Mrs Green really feels, behind that Mona Lisa smile? Will you know how to observe her, will you and your colleagues know just what you are looking for?

Did you miss that opportunity with the patient, carer - family in the POLITICAL domain to resolve the (ongoing Sunday afternoon) issue? You know the one about mum's medication, agitation, the appropriateness of the care environment and the outstanding referral to the community mental health team? Well yes, you might wonder what that buzz is. It's a complaint just passing you by(e).

Basic, holistic, integrated, person-centered care and much more. Now that's the real puzzle.
A puzzle worth spending a whole career trying to find the pieces - never mind the solution ....

Simply the best... 4-Domains Pale Ale!

Drugs and alcohol
have permeated
our various cultures and
civilization for millennia.

Our models of health and social care should reflect this. ...

More to follow on drugs, dementia and the Berlin Wall.
I just had to get this out of my system ...

Image sources:

http://www.hbclark.co.uk/clarks-brewery.html
http://www.wordforwine.co.uk/jwlees/index.php
http://www.woodmoorbeer.org/Pages/Snordog_Kenya_Labels.html

16th Int. Reflective Practice Conference UK

Reflection in action: June 23-25th 2010

Date: 23-25 June 2010 (3 day event)

Venue: Bedford campus, Bedford, MK41 9EA, UK.

This cutting edge conference was conceived in 1994 as a forum to enable health care professionals undertaking study at the University of Bedfordshire to share with a wider audience how reflective practice had enabled development of both self and clinical health care practice. Since that event, the conference grew rapidly into an international conference hosted by different organisations world-wide.

In 2010 the conference, for the first time, becomes truly inter-professional spanning the breadth of the University’s portfolio from business to midwifery, from theatre to social work, from psychology to sports science and many places in between. What unites these professions is a common interest in reflective practice as professional practice, education and research. It makes a difference.

We live our lives through stories not theories. Through stories we find meaning and grow. It makes sense then that we teach and learn through stories and in doing so, pay attention to theories that meaningfully inform our lives no matter the nature of our practice.

Reflection in action

Convened by Prof Christopher Johns, University of Bedfordshire, this conference aims to engage individuals from multiple disciplines including health, education, business and creative sectors.

Call for papers

Click here (no longer) for more information.

How to submit abstracts

Please send your abstracts to ....

-------

It would be marvellous to co-author a paper for this or a similar conference. Hodges' model is ideal as a reflective resource, being one of its original purposes. Something for me to reflect on currently is World Usability Day.

Conceptual spaces and innovative environments

Continuing to read Scott Berkun's the myths of innovation there is a really useful reference and illustrative source for Hodges' model.

The reference I must chase is - according to Berkun on page 90 - Alex F. Osborn's excellent book Applied Imagination. It is Osborn who apparently coined brainstorming and the management and creative industry of which Hodges' model is a (small) part. There's much more here as the original brief on how to - has been corrupted, consequently failed in application and lost its potential.

Later in the text Scott highlights the importance of environment and management's contribution to creating and protecting innovative assets (teams), that may not be valued in the rest of the organization. Berkun quotes Tom Kelly (IDEO) who notes that:

Innovation flourishes in greenhouses. What do I mean by a greenhouse? A place where the elements are just right to foster the growth of good ideas. Where's the heat, light, moisture, and plenty of nurturing. The greenhouse we're talking about, of course, is the workplace, the way spaces take shape in offices and teams work together. p.103.

Guess what - does this h2cm translation make sense to you....?

Light	Heat
Moisture	Nurturing

'Light'? Well I know there's E=mc² but here it's about purpose, leadership, spirit and belief.
'Heat'? This is the current physical element, technical white heat, global heat and need.
'Nurturing'? Great managers nurture and create the political space for innovation.
'Moisture'? Well this is to be found in the sociological domain: think about it....! ;-)

I never thought of Hodges' model as a greenhouse, but then it is far more than a brainstorming plug-in. Maybe it can act as a catalyst for change for you?

h2cmng AT yahoo.co.uk

Ref. Osborn, Alex (1953). Applied Imagination: Principles and Procedures of Creative Problem Solving. New York, New York: Charles Scribner's Sons. ISBN 978-0023895203.

The art and science of nursing: the poetry of caring

Another quote:

... The best translators seem to have an extra ear, indeed, have to have an extra ear, for the literary dimensions and possibilities of their own language. Translation can draw the poet out of someone who may not have realised the poet in himself. The response to poetry is in us all but it takes an extra talent to turn response to invention, to hear and speak echo in a fresh voice. ...


George Szirtes, The Times, Words with a fresh voice, 7 November 2009, p.8.


Original image source with thanks: Alikaragoz.net

Innovation and the 'middle' in NHS computing

Let's start with a quote:

Information systems are no longer associated mainly with data processing; they are increasingly seen as a management tool and an aid to action. This means that the costs of failure are much greater, and these costs are incurred when expensive systems are not used or are inadequately used. Surveys have shown that in as many as half of systems there are large gaps between users' expectations and the system's performance.

When do you think the above was written?

Here's the reference:

Mumford Enid (1991) Need for relevance in management information systems: what the NHS can learn from industry. BMJ. June 29; 302(6792): 1587–1590

1991: quite sobering really.

Previous - part-time - work reviewing data standards proposals focuses the mind in terms of the role of standards in interoperability, service impact and other essential assessment qualities. As the NHS has sought to implement standards as with the National Programme for IT you are also aware of the clamour for creativity and innovation. Innovation is there in the title of agencies.

I have long pondered about the extent to which - like Nature and vacuums - standards abhor innovation and creativity. How much is the 'standard' about doing things by the 'book' ... page 57 : para.3 ...

My eye caught the viewpoint piece in this week's Computing -

If you approach the world positively, a downturn is a good time for innovation. The shortage of people and money can create the pressure that leads to creativity. There are three areas where action will help organisations succeed in exploiting IT to enable business innovation:
Kick out Prince2

What more is there to say about innovation and Prince2? The focus of the Prince2 project management methodology – on organisation and control, and defining what to deliver before you have begun – is death to innovation. It is a bad solution trying to solve the wrong problem. It takes the IT profession in the wrong direction if we want to contribute to business innovation. It has to go. The agile development movement provides much stronger foundations for succeeding with projects that result in business innovation.

Ashurst, Colin, Viewpoint: How to use IT to enable innovation, Computing, 5 November, 2009.

Of course there IS a world of difference between information standards and project management standards, but there is no escape from the need for (effective) management of transition and change WITH business continuity. Within that management - engagement approach (as per agile) -

+++++++ socio-technical +++++++

- perspectives, as highlighted by Mumford (and others) all those years ago must have a place.

Additional link:

BCS Sociotechnical Specialist Group

Global reach 4 a model in search of creative, innovative (caring) minds

"An idea is not an innovation until it r e a c h e s people." p.45
the myths of innovation, scott berkun
O'Reilly

At Drupalcon Paris in September in his keynote Dries (Buytaert) highlighted the importance of reach in that mix of:

RICHNESS + R E A C H = SUCCESS

As per the 'badge stack' lower right in a search for traffic a while back I registered with a real-time feed search service. I realised I had not replied to them following a request for extra details. Here's what I have sent through for "Words from the Author(s)":

Welcome to the QUAD is an experiment of sorts. What I hope will prove a valuable stepping stone from a static website c.1998-2005 to a new dynamic, database driven resource devoted to Hodges' model and related learning. The blog reflects this - and I hope the creative potential of Hodges' model which is an *open* conceptual framework. This explains the scope and range of the blog across nursing, health, education and informatics. I am planning to use Drupal for the new site and although comments are disabled my e-mail is available so please get in touch. Always open to hear from people using the model, and keen to learn of the features and content types users of a new site might wish to see.

One of the appeals of this service and the growing archive of content on W2tQ is their goal to allow users -

to serendipitously discover high quality,
but less popular feeds located in the long tail of feeds.

I've been using Clustermaps for quite a while and have the visitor's map updated every month, here is the (clickable) map for W2tQ through October 2009.

1,844 hits for last month,
that's terrific:
thanks to everyone for your support!

Watch this caring space: Workshop - Robots 4 independence

The KT-EQUAL initiative has another event scheduled for later this month, another workshop on the application of technology to improve the quality of life of older people and their carers. Please find the call copied below. The workshop I attended in September and reported on here was very enjoyable and a great source of information and inspiration.

The topic for the 24th November paradoxically sends me back to The Which Computer Shows at the NEC in Birmingham which I used to attend with my father. In the late 80s and 90s the pace of change was clear to see. The topic for the 24th November is Robots and of course they are already everywhere, but the combination of:

• demographic change - ageing population(s)
• hence need to focus the skills and knowledge of the care workforce
• emerging and refinement of safety and quality standards
• design and innovation
• the rise of 'single households'
• mobile comms and ubiquitous computing
• the expectations of the baby-boomer generation (and those who follow!)
• lessons learned through early telecare(?)
• and much more besides

- means that change isn't just on the cards, it's in neural nets, speech synthesis and the programme for this event. So as they say watch this space - it will change and move! Here is a marvellous opportunity to find out what is really happening in this field ....

---

Robots supporting personal independence and rehabilitation

This workshop organised with the University of Hertfordshire will present and discuss the role of technology in the rehabilitation of older people and children, including some of the latest developments in the use of 'robotic' technologies. The perspectives of research scientists, clinicians and users will be explored through presentations, videos and breakout sessions.
Hosted by: University of Hertfordshire
Sponsored by: KT-EQUAL
Event organisers:
Dr Farshid Amirabdollahian, University of Hertfordshire
Professor Kerstin Dautenhahn, University of Hertfordshire
Professor Gail Mountain, KT-EQUAL Director
Verity Smith KT-EQUAL Coordinator
Date: 24 November 2009

Venue: The Comet Hotel (Ramada Hatfield Hotel)
St. Albans Road West
Hatfield, AL10 9RH
Hertfordshire
United Kingdom

This workshop aims to stimulate debate among key stakeholders regarding the nature of assistive technologies developed using the latest developments in robotic technologies.
It will include presentations from experts working across the spectrum of development, from basic technology to neuroscience.
The workshop will be of interest to a wide range of practitioners and policy makers, health and social care practitioners, employers, charitable and government bodies concerned with the needs of older and disabled people, as well as researchers and academics from engineering, biological, social science, medical and health care disciplines especially those who are interested in looking forward to a time when radically new technologies will be available. Older people are especially welcome at this workshop.
There is no charge for attendance just an enthusiasm and interest in extending the quality of life through informed user-focused research and its application. Registration is essential. To book a place, please refer to the registration page.

h2cm: windows on the mind, body, society and State

h2cm is not just a window and handle on the mind and that of patients and carers.

h2cm can reflect (as per its original purposes):

• health and social care policy;
• the aspirations of local care communities and economies;
• signs, symptoms - priorities;
• care plans, actions and care pathways;
• research objectives;
• procedures;
• ethical deliberations;
• recovery, relapse prevention;
• information requirements;
• learning objectives;
• and outcomes.
• ...

HOW Hodges' model can achieve this...?

Now that IS the question that can really open the windows, whether you believe in four or five....


Image source: with thanks to - FineArtAmerica.com: and the artist of -
I Marry Your Mind to Lights Window, Stephen Lucas

Drugs, Policy and spent Energy

The ongoing controversy here in the UK over drugs policy amid the sacking of Prof. David Nutt - chairman of the Advisory Council on the Misuse of Drugs and since Friday the resignation of other members highlights the tension between the SCIENCES and POLITICS.

As a father, mental health nurse (and light imbiber of real ale and wine) all I know is that the government has been lobbied for decades by concerned groups over the risks of excessive alcohol consumption. With changes in alcohol licensing opening hours and pricing/tax it seems the government has the local town centres and community legislation it deserves.

Given the current spat you might think that within Hodges' model the SCIENCES and POLITICAL domains would be diametrically opposed? But no! There they are bosom buddies on the mechanistic side of the model.

Although the clue is in the title - advisory - as to the extent to which the government is bound to follow advice, the government's policy, advisory groups and policy should be in accord as far as the media and public are concerned.

Otherwise what price for evidence-based politics?

For individuals and communities alike we need order between the SCIENCES and POLITICS otherwise chaos reigns. Order does not just fall out of the tree. The issues here include at risk youngster's for whom exposure to cannabis might precipitate a psychotic episode; the granularity of a classification of drugs for legal purposes and that for clinical and social care. The debate is complex and takes work and energy on many levels. There are many dimensions to appreciate in this situation:


While very unfortunate, this is timely as I read Ben Goldacre's Bad Science.

You do have to worry about the position of
common sense.

There are other sources of heat already on the boil with many spillages to follow. These will arise from the friction of SCIENCE, climate change and policy. Ah bliss to live in interesting times. ...